Description: Dental care is an important component of everyone's health, and senior citizens are no exception. With no public dental coverage under traditional Medicare, seniors must seek other ways to obtain dental insurance, pay for services out of pocket, or go without care. In this session we will review the importance of oral care to overall health, the current state of public and private dental insurance for seniors, and innovative ways to reach this population. Medicare, Medicare Advantage, Medicaid, and other types of dental coverage will be discussed by three actuaries with different areas of expertise in the senior dental market.

Description: Morbidity improvement has been a hot topic in the LTC market in the past year. This session will provide an update of studies performed in the industry to review historical data for morbidity improvement and considerations that actuaries should take when determining what level of morbidity improvement to include in their best estimate assumptions.

Description: Large claims have always been a major source of volatility in health care claims experience. In this session, the presenters will discuss techniques for analyzing large claims, predicting large claims and measuring the associated risk. The presenters will also discuss the early results of the SOA 5/50 research project which will examine the 5% of the population that accounts for 50% of the health care costs.

Description: This is a case study session where the speakers will describe a project where a major health system converted its provider distinct reimbursement (i.e., separate physician IPA and hospital capitation) to an integrated reimbursement involving global capitation. The session will discuss the strategic issues considered by the parties and how they evaluated them in their decision process. This session will provide attendees an example of how to approach this type of decision.

Description: Underwriting is one of several areas in the insurance industry being impacted by insurtech. In this session, we will hear from experienced experts in underwriting transformation. Digitization, machine learning and other approaches are among topics to be discussed.

Description: Beginning with the 2019 Benefit Year, CMS (the Centers for Medicare and Medicaid Services) has provided guidance that allows Medicare Advantage Plan Sponsors much greater flexibility in tailoring benefits to promote clinical, care management, and financial goals. The guidance allows for a broader menu of supplemental benefits and also enables plans to target benefit enhancements to beneficiaries afflicted with specific disease states. This session explores the ramifications of the policy changes on Plan Sponsors and beneficiaries, and discusses the different ways that Plan Sponsors are taking advantage of the additional flexibility.

Description: On December 21, 2018, the Centers of Medicare & Medicaid Services (CMS) released the final rule for Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program. 'Pathways to Success' makes sweeping changes and will push ACOs to assume financial risk more quickly. This session will discuss the key changes in the final rule, reasons why providers would remain in the program while being forced to downside risk, and how actuaries can add value to providers who will be taking on millions of dollars of risk in the coming years.

Description: Principal Analyst Laurie M. Orlov of the Aging in Place Technology Watch will present a roadmap for the technology and ITSS marketplace. She will explore where it has been, what it does best, where it is going, and the challenges it faces. She has been a leading researcher and independent analyst in this field for more than 20 years.

Description: There has been a proliferation of proposals to expand access to public health insurance plans, either to strengthen insurance markets under the Affordable Care Act (ACA) or to replace the ACA marketplaces or other health insurance programs altogether. These proposals range from creating a public plan that would operate alongside private plans in the ACA marketplaces, to allowing individuals to buy into Medicare or Medicaid, to expanding Medicare to all. The terms used to describe these various options are often used interchangeably but they would be structured differently and have different impacts depending on the implementation details. Panelists at this session will discuss the general approaches for expanding access to public plans and their potential implications.

Description: "The always popular Medicaid Hot Topics session is back with discussions from an expert panelist on the most riveting Medicaid topics of the year. These could include the following: • ACA court battles - what are the potential impacts on Medicaid? • CMS continues to open the door for state flexibility - just what can states now do differently?• Where are we on Medicaid work requirements? • How will the changes to the mega-rule impact Medicaid?• High cost drugs and how states are sharing risk for them (carve-out, risk pools, risk sharing)• And more current topics of interest to Medicaid actuaries!Medicaid is dynamic and it is difficult to stay up to date on all of the changes. This session provides insightful discussion into the major changes that impact actuaries and their companies or state clients"